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Patient handout

Hepatocellular Carcinoma (HCC, BCLC-staged)

PRODUCTION

1. Your condition

This handout is for hepatocellular carcinoma (hcc, bclc-staged). Your care team identified this based on: suspicious liver lesion on surveillance us (aasld 2023 singal).

Other reasons your team may use this plan: elevated afp >20 ng/ml in cirrhotic patient (aasld 2023 singal); liver mass on ct/mri (incidental or surveillance recall); known hcc on problem list (follow-up, staging, treatment response).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
surgical resectionAASLD 2023 Singal — resection preferred for single HCC in non-cirrhotic or compensated cirrhosis without portal HTN
radiofrequency ablation (RFA)AASLD 2023 Singal — RFA for lesions <=3 cm with equivalent survival to resection in select patients
microwave ablation (MWA)AASLD 2023 Singal — MWA alternative to RFA; faster ablation, fewer heat-sink effects
liver transplantationAASLD 2023 Singal — transplant cures both HCC and underlying cirrhosis; Milan criteria (single <=5cm or <=3 each <=3cm, no vascular invasion, no extrahepatic disease)

Plan: BCLC-staged HCC treatment — AASLD 2023 Singal + NCCN 2024

3. When to call your provider

Contact your care team if any of the following happen:

  • Tumor rupture (acute abdomen, hypotension) then ED + emergent TAE (AASLD 2023 Singal)
  • Immune-related adverse event grade 3-4 then hold IO + high-dose steroids (NCCN 2024)
  • Variceal bleed on bevacizumab then discontinue bev permanently + manage bleed (IMbrave150)
  • Decompensation (new ascites, HE, jaundice) then reassess Child-Pugh and BCLC (AASLD 2023 Singal)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • Spontaneous HCC rupture with hemoperitoneum — acute abdomen, hypotension, dropping Hgb (AASLD 2023 Singal)(life-threatening)
  • Macrovascular invasion of main portal vein by HCC — BCLC-C, contraindicates TACE (AASLD 2023 Singal; EASL 2018)
  • Grade 3-4 immune-related adverse event on atezolizumab-bevacizumab or durvalumab-tremelimumab (NCCN 2024)
  • GI bleeding (variceal or non-variceal) while on bevacizumab (IMbrave150)(life-threatening)

5. Follow-up

Multidisciplinary tumor board review; transplant center coordination; palliative care integration for BCLC-D; survivorship if complete response; ongoing cirrhosis management (AASLD 2023 Singal)

6. Sources

Guideline: AASLD Practice Guidance on Diagnosis, Staging and Management of HCC (Marrero, Hepatology 2018) + landmark systemic-therapy RCTs (SHARP, IMbrave150, HIMALAYA)

  1. pubmed.ncbi.nlm.nih.gov/29624699
  2. pubmed.ncbi.nlm.nih.gov/18650514
  3. pubmed.ncbi.nlm.nih.gov/32402160